HEALTH CARE/Joan Retsinas

The Mark of C, for Crazy

Should Woody Allen, who has showcased his neuroses, own a machine gun that can strafe a schoolroom in 2 minutes? What about the cat-lady down the street, who hoards newspapers, cartons, and stray cats? Can the man with catatonic schizophrenia, living in a group home, buy a carbine?

Clinging to the Second Amendment, a cadre of Americans, bolstered by a powerful gun industry, has blocked Uncle Sam from regulating guns. Congress even let the 10-year Federal Assault Weapons Ban expire in 2004.

The mantra of the zealots: Guns don’t kill people. People kill people. But the past few massacres (Columbine, Aurora, Sandy Hook) have made even zealots acknowledge the danger of weapons that let anyone play Rambo.

So their mantra has changed. Crazy people – or, to be kinder, mentally ill people – kill people. The solution du jour is as idiotic as the mantra: keep people with mental health illnesses from buying automatic weapons. The Second-Amendment lobby is willing to restrict the sale of military-style weapons: no sales to people with mental illness. If you haven’t been judged crazy, and have no criminal record, you can whip out a VISA and fire away.

This suggestion is too nutty to take seriously – but since legislators at both state and national levels, eager to placate the gun-lobby, are taking it seriously, we all should.

The first stumbling block is the definition of mental illness. The diagnostic manual for psychiatrists lists more than 300 diagnoses; e.g., depression, bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder. So which diagnoses should gun-regulators hone in on? And should gun-regulators differentiate chronic from episodic illness?

The second stumbling block is privacy. Stringent patient confidentiality laws protect patients. Physicians are not supposed to reveal diagnoses of patients to anyone. The Tarasoff rule lets clinicians alert law officials when a specific patient poses a credible harm to others, but that is a narrow exclusion to patient confidentiality. Implicitly any law that requires gun-dealers to do a “background mental health check” on prospective buyers presupposes a mega-registry, like a data base of criminals. Presumably psychiatrists throughout the country would e-mail the names, addresses, and diagnoses of their patients to a central data base, easily accessible to dealers.

This registry would be huge. One estimate pegs the percentage of Americans with “any mental illness” at 20%; the percentage with a “serious mental illness” at 5%. A lot of Americans – including some legislators – would end up with their illnesses on-line.

A mega-registry sets treatment back a century. We want people to seek help for mental illness: it often is treatable, if only a patient would seek help. The promise of confidentiality has eased the way for people to seek help. Plus we have been trying to erase the stigma of mental illness, again, to encourage people to seek help.

The third stumbling block is reality. Even if we identified every person with a serious mental illness, and if we barred them from buying AK-14s, we wouldn’t dramatically reduce the number of massacres. Most mass-killers are judged deranged only after their heinous act; before, they were “loners,” or “troubled,” or, often, “normal.” Even if they sought counseling beforehand, the counselors didn’t recognize them as dangerous. In fact, people who suffer from mental illness are more likely to hurt themselves than others.

Crucially, the link between the arsenal and the murderer is often indirect. Sometimes a murderer didn’t buy the weapons himself – the Sandy Hook killer got his arms stash from his mother, an elementary school teacher. Teenagers grab guns from family gun-closets. Criminals steal guns. A black market lets guns circulate, for a price.

The gun-lobby is right: people pull the trigger. But these triggers are horrific. We can stop people from pulling the trigger, not by stigmatizing the vast number of Americans suffering from a mental illness, but by banning automatic weapons.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.